. Text-book of operative surgery . the whole acromion is to be removed,the incision extends at once into the acromio-clavicular Joint. If a portion of theacromion is to be preserved, the bone is divided with the chisel at the place selected. The lower triangulär Aap is thrown back over the posterior fibres of the deltoidanteriorly, and the ascending portion of the trapezius posteriorly, as far as the upperedge of the latissimus dorsi. The finger is introduced under the exposed posteriorborder of the deltoid, and the muscle is divided (if the disease admits) close to thespine and acromion as fa
. Text-book of operative surgery . the whole acromion is to be removed,the incision extends at once into the acromio-clavicular Joint. If a portion of theacromion is to be preserved, the bone is divided with the chisel at the place selected. The lower triangulär Aap is thrown back over the posterior fibres of the deltoidanteriorly, and the ascending portion of the trapezius posteriorly, as far as the upperedge of the latissimus dorsi. The finger is introduced under the exposed posteriorborder of the deltoid, and the muscle is divided (if the disease admits) close to thespine and acromion as far as the acromio-clavicular Joint, or to the place where theacromion has been chiselled through. In this way the posterior surface of the shoulder-joint, together with the tendonsof the externa! rotators, is exposed in the same way as in our method of excisingthe shoulder-joint by the posterior incision. If the articular portion of the scapulacan be retained, muscle after muscle is cut across upon an elevator, or upon the finger. Fig. 187.—Excision of the scapula. AMPUTATIONS AND DISARTICULATIONS 329 introduced beneath them. If, however, the articular portion of tlie scapula must beremoved, the tendons are detached from the head of the humerus just as in excisionof the shoulder-joint, viz. the supraspinatus, infraspinatus, and teres minor from thegreater tuberosity, the subscapularis from the lesser tuberosity, and farther down theunited insertions of the latissimus dorsi and teres major muscles from the innerbicipital ridge. The circumflex nerve and the posterior circumflex artery are to be avoided, or thelatter may have to be ligatured at the lower border of the teres minor, whilst fartherbackwards the dorsalis scapulae artery must be ligatured. Next follows the division of the trapezius. The finger is introduced under itsfibres from the place where the acromion is divided, and the muscle is detached alongthe acromion and spine. The acromial branches of the acromio-thoraci
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